AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Fluoroscopy and Femoroplasty-Cara Beth Lee, MD

Fluoroscopy and Femoroplasty-Cara Beth Lee, MD

Pdf Summary

This document, authored by Dr. Cara Beth Lee, details the critical role and methods of using fluoroscopy during hip arthroscopy to enhance surgical safety and efficacy. Fluoroscopy provides a dynamic intraoperative view, complementing arthroscopic visualization to ensure thorough osteoplasty and safe anchor placement.<br /><br />The introduction emphasizes fluoroscopy’s necessity for simulating open dynamic exams and protecting both surgeon and patient through appropriate lead and eye protection, as well as optimized source positioning. The preoperative plan involves detailed imaging assessments of both the acetabulum and femur, including AP pelvis radiographs, 45-degree Dunn views, false profiles, MRI radial sequences, and femoral version measurements.<br /><br />Intraoperative steps focus on proper patient positioning with pelvis orientation confirmed so the C-arm is perpendicular to the femoral neck, typically angled about 40 degrees relative to the femur. The fluoroscopic exam employs consistent AP views with the foot fixed and variations through hip extension, internal and external rotations, and flexion positions, mostly correlating to clock-face positions (e.g., 11:45, 12:30, 1:00, etc.) to visualize the hip anatomy and deformities comprehensively.<br /><br />The technique includes dynamic exams with foot free and C-arm rotations up to 65 degrees to obtain rim views critical for anchor placement, as well as repeating dynamic assessments after osteoplasty to test anterior hip stability. Specific fluoroscopic views such as the rim view (C-arm rotated 25 degrees) help visualize anterosuperior rim and cam lesions.<br /><br />Intraoperative tips highlight maintaining caution near the thin rim at the psoas U, visualizing neurovascular structures during femoral osteoplasty, and continuing resection down to the neck base. Systematic fluoroscopic technique reduces radiation time with experience and optimizes outcomes by ensuring complete lesion correction and safe procedural steps.<br /><br />In summary, adopting a consistent, reproducible fluoroscopy protocol is essential for managing the variable hip pathology during arthroscopy, maximizing surgical safety, and minimizing fluoroscopy duration.

Keywords

fluoroscopy

hip arthroscopy

osteoplasty

anchor placement

intraoperative imaging

patient positioning

C-arm technique

hip stability assessment

radiation safety

dynamic hip examination